Endoscopic Therapy for Weight Regain After Bariatric Surgery

Obesity and its comorbidities have reached epidemic proportions across an ever-expanding area of the world. Nonsurgical means of weight reduction offer limited potential for consequential and sustained weight loss, effective in fewer than 5% of cases; billions of dollars are spent on diets, lifestyle changes, and pharmaceuticals with disappointing long-term results. After losing weight for 12–18 months postoperatively, the patient reaches a balance between energy intake and expenditure, and a stable body weight is typically achieved. Gastrointestinal weight loss surgery, in contrast, has been shown to be effective and is finding increased use. About 20% of patients fail to reach postoperative success, defined as >50% EWL within 1 year of surgery. With continued growth in the number of bariatric procedures performed and an increase in the duration of follow-up, we will need to prepare for a cumulative surge in patients requiring intervention for postoperative weight regain. Less invasive endoluminal revisions that reduce gastric pouch size and gastrojejunal anastomosis (GJA) diameter are thought to have a more favorable risk profile in this population. A variety of techniques have been evaluated; sclerotherapy, endoluminal suturing devices, tissue plication platforms, and other emerging technologies will be discussed here.